The Nature and Treatment of the Stress Response: A Practical Guide for Clinicians

Barely more than twenty years ago the inquiry into the nature and implications of the psychophysiologic stress response seemed to be restricted to laboratory animals. Today, however, scientists from a wide range of disciplines are studying stress and its implications for human health and disease. This may be because our technical ability actually to measure the phenomenon has increased, as has our understanding of human psychophysiology. Just as important, how­ ever, may be the fact that we have entered a new era of disease. According to Kenneth Pelletier, we have entered upon an era in which stress plays a dominant role in the determination of human disease. Pelletier has stated that up to 90% of all disease may be stress-related. Whether this estimation seems inflated or not, the fact remains that clinicians of all kinds, including physicians, psychologists, physical therapists, social workers, and counselors, are daily being confronted with clients suffering from excessive psychophysiologic stress arousal. This fact has created a need to know more about the stress response and its treatment. Although more and more health-care professionals are directly or indirectly working with clients who manifest excessive stress, there has been no text previously written which attempted to condensE' between the covers of a single volume a practical, clinically compre­ hensive discussion of what stress is (as best we currently understand it) and how to treat it when it becomes excessive.

One The Stress Response and Its Treatment.- 1 What is Stress?.- Defining Stress.- Treating Excessive Stress—Clinical Assumptions.- Plan of the Book.- Two The Nature of the Stress Response.- 2 The Nervous Systems and the Stress Response.- The Organization of the Human Nervous Systems.- to the Stress Response.- The Initiation of the Stress Response—CNS Mechanisms.- Neural Axes—Stress Response via Direct Neural Innervation of End-Organs.- “Fight or Flight” Response—The Neuroendocrine Axis.- Endrocrine Axes and the “General Adaptation Syndrome”.- Posterior Pituitary Axis.- Summary—The Stress Response.- 3 From Stress to Disease.- Theoretical Bases for the Development of Stress-Related Diseases.- Lachman’s Model.- Sternbach’s Model ,.- Gastrointestinal Disorders.- Peptic Ulcers.- Ulcerative Colitis.- Cardiovascular Disorders.- Respiratory Disorders.- Allergy.- Bronchial Asthma.- Hyperventilation.- Musculoskeletal Disorders.- Skin Disorders.- The Immune System.- Psychological Manifestations of the Stress Response.- Summary.- 4 The Measurement of the Stress Response.- Chemical Measurement.- 17-OHCS.- Catecholamines.- Electromyographic Measurement.- Cardiovascular Measurement.- Electrodermal Measurement.- Psychological Measurement.- Minnesota Multiphasic Personality Inventory (MMPI).- The Sixteen Personality Factor (16 P-F).- Taylor Manifest Anxiety Scale (TAS).- State-Trait Anxiety Inventory (STAI).- Affect Adjective Checklist (AACL).- Subjective Stress Scale (SSS).- Profile of Mood States (POMS).- Law of Initial Value.- Summary.- Three The Treatment of the Stress Response.- 5 Self-Responsibility as a Therapeutic Force.- Human Development and Self-Responsibility.- Philosophical Perspectives on Self-Responsibility.- Self-Responsibility and Excessive Stress.- The Role of Therapeutic Client Education.- The Role of Counseling and Psychotherapy.- Summary.- 6 Dietary Recommendations and the Stress Response.- Summary.- 7 The Pharmacological Treatment of the Stress Response.- Sedative-Hypnotics—An Introductory History.- The Barbiturate Sedative-Hypnotic Agents.- Nonbarbiturate Sedative-Hypnotics.- The Antianxiety Agents.- The Propanediols.- The Benzodiazepines.- Antihistamines.- Beta Adrenergic Blocking Agents.- Tricyclic Antidepressants.- Phenothiazines.- Summary and Conclusions.- 8 The Clinical Use of Relaxation Techniques: General Considerations.- Rationale for the Clinical Use of Relaxation Techniques.- Individual Client Differences in Relaxation.- Clinical Precautions and Undesirable Side Effects.- Loss of Reality Contact.- Drug Reactions.- Panic States.- Premature Freeing of Repressed Ideation.- Excessive Trophotropic States.- Summary.- 9 Meditation.- History of Meditation.- Types of Meditation.- Mechanisms of Action.- Therapeutic Hallmarks to the Supraconscious State.- Research on the Clinical Applications and Effects of Meditation.- How to Implement Meditation.- Preparation for Implementation.- Components within Meditation.- Example Protocol.- Summary.- 10 Neuromuscular Relaxation.- History of Neuromuscular Relaxation.- Mechanisms of Action.- Research on Clinical Applications and Effects of Neuromuscular Relaxation.- How to Implement a Physically Active Form of Neuromuscular Relaxation: Preparation.- How to Implement Neuromuscular Relaxation: Procedure.- The Sequential Steps to Follow for Each Muscle Being Relaxed.- Example Protocol.- Summary.- 11 Voluntary Control of Respiration Patterns in the Reduction of Excessive Stress.- History.- Basic Patterns of Breathing.- Mechanisms of Action.- How to Implement.- Summary.- 12 Biofeedback in the Treatment of the Stress Response.- History.- Biofeedback Modalities.- Electromyographic (EMG) Biofeedback.- Temperature Biofeedback.- Electroencephalographic (EEG) Biofeedback.- Electrodermal (EDR) Biofeedback.- Precautions.- Role of the Therapist.- Summary.- 13 Healthful Expression of the Stress Response through Physical Exercise.- History of Therapeutic Exercise.- Mechanisms of Action.- Research on the Clinical Applications and Effects of Exercise.- The Exercise Program.- Types of Exercise.- Amount of Exercise Needed.- Warnings in the Use of Physical Exercise.- Summary.- 14 The Use of Hypnosis in the Treatment of the Stress Response.- History.- Mechanisms of Action.- Research on the Clinical Applications.- Hypnotic Screening.- A Word about Hypnotic Induction.- The Use of Hypnosis for Stress Reduction.- Summary.- 15 Putting It All Together: Holism and Holistic Treatment of the Stress Response.- The Nature of Holism.- A Holistic Treatment Model.- Preliminary Activities.- Holistic Intervention.- Summary.- Epilogue.- Appendix A Relaxation Training Report.- Appendix B Physically Passive Neuromuscular Relaxation.- Appendix C Professional Associations and Journals as Resources on the Topic of Stress.- References.- About the Authors.